VAD Law in QLD

From The Conversation

Queensland has become the latest Australian state to move forward on the issue of voluntary assisted dying. Draft legislation, developed by the Queensland Law Reform Commission, is expected to be tabled in parliament next week.

This reflects moves across the country over the past few years to permit voluntary assisted dying (also sometimes called voluntary euthanasia).

The Queensland laws, if passed, would be similar to those in other states, but not identical.

The Process

The LNP gets a conscience vote From New Daily Queensland Opposition Leader has reaffirmed his support for a conscience vote on assisted dying.

The state could become the fourth to legalise euthanasia, with Premier saying the proposed laws to be introduced to parliament this week are aimed exclusively at people suffering or dying.

Mr Crisafulli says he will approach the debate with an open mind and that’s “exactly what I’m asking from my team”.

“It’s a serious issue and it deserves a serious response,” he told reporters on Sunday.

“When I talk about a conscience vote, I mean it. I don’t mean the kind of conscience vote where people get heavied and there will be people leaning over others’ shoulders.”

Mr Crisafulli also said he had no expectation that his own stance on the issue would become a signpost for his LNP colleagues.

“Whatever decision I come to, I don’t want to see people following that like a conga line,” he said.

“I want people to treat this with respect. I know that passion exists on both sides. I’ve seen it and I respect it.”

Ms Palaszczuk, a Catholic, said last week she would allow her own MPs to vote according to their conscience after witnessing the slow and painful deaths of her grandmother and uncle.

“This is a choice, and it’s not going to be the right choice for a lot of people, but it’s got to be an option for people and far be it for me to make that individual choice on how a person wishes to end their life,” she said.

The Greens and independent MP Sandy Bolton support euthanasia but Katter’s Australian Party will oppose it.

One Nation MP plans to study the bill before deciding. Under the bill, patients must have either a disease, illness or medical condition that is advanced, progressive and will cause death.

Their condition must be expected to cause death within 12 months and cause “intolerable” suffering.

Patients will have to be assessed to be acting voluntarily and without coercion, aged at least 18 and a Queensland resident.

They will also need to make three applications over a period of at least nine days.

Health practitioners must tell applicants they can change their mind at any point.

The bill will be debated in September and, if it passes, a euthanasia system will be in place by May 2022. Institutional Conscience? From The Australian

The churches operating Queensland’s biggest private hospitals and nursing homes have warned they will be forced to facilitate voluntary euthanasia for dying people under legislation to go before state parliament next week.

Catholic Archbishop of Brisbane Mark Coleridge and the Uniting Church’s Queensland moderator, Andrew Gunton, said the draft bill released by Premier Annastacia Palaszczuk failed to deliver a promised right of “institutional conscientious objection”.

Dr Coleridge said the legislation would allow patients who requested help to die but were too ill to be moved from a Catholic hospital to bring in outside doctors to assess them and potentially administer a death-dealing dose.

“That was something that surprised and concerned me about the draft bill,” he said. “It seemed to give with one hand and take with the other — what seems to be a concession to the rights of institutional conscientious objection is in fact no real concession at all.”

Reverend Gunton said if aged care home clients were classed as permanent residents they could demand that a request for VAD by carried out on site, even though the Uniting Church was adamant it would have nothing to do with euthanasia.

“It seems incredibly unfair and not to what the spirit we thought this was going to be, having institutional conscientious objection,” he said. “We think it undermines the very principle which we are fighting for — our right to express our faith-based values in the facilities we run.”

Catholic Health Australia provides one in five hospital and aged care beds in Queensland, listing in its portfolio Brisbane’s Mater Hospital group and Mercy Community Services, while the Uniting Church runs four major health care centres, including the Wesley Hospital, also in Brisbane, as well as 47 nursing homes statewide.

While the draft legislation framed by the Queensland Law Reform Commission recognises the right of conscientious objection for medical staff and for institutions to advertise a faith-based position against VAD, Reverend Gunton said the bill otherwise was “incredibly vague”.

Catholic Health Australia chief executive Pat Garcia said the existing provisions would force faith- based hospitals and homes to enable VAD on the premises.

“There is no choice in that,” he said. “We have to consider the impact this supposedly voluntary scheme will have on nurses, residents and patients who choose to work, live and be treated in facilities that have expressly said they will not offer VAD. It’s a serious anomaly that must be addressed.”

Deputy Premier Steven Miles said the QLRC framework allowed any institutional “entity” to opt out of VAD, but it would be required to transfer a person who qualified for assisted dying to somewhere else that allowed it. “In some situations, requiring an individual to leave their home and transfer to a different hospice, when they’re close to death and in great pain, would subject them to pain and distress or deny them access to VAD,” he said. “It’s important the VAD scheme provides all Queenslanders who are suffering and dying with equal end-of-life choices, irrespective of where they live.”

Mr Miles and Attorney-General attended a meeting with church representatives on Thursday where their concerns about being roped into VAD were put. There would be a 12-week period of further consultation after the Bill was introduced next week by Ms Palaszczuk.

Queensland is the fifth state after Victoria, Western Australia, Tasmania and South Australia to enact or introduce the right to die for terminally ill people.

S.9

A quick recap Victoria’s law was passed in November 2017 and came into force in June 2019 after an 18-month implementation period.

Next was Western Australia, whose 2019 law will come into effect on July 1, 2021.

Tasmania passed a voluntary assisted dying law in March this year, set to begin in 2022.

And South Australia’s lower house is now considering its own bill, after the upper house approved the proposed law earlier this month.

In New South Wales, independent MP Alex Greenwich is drafting a voluntary assisted dying law. It’s due to be released in July for consultation. The Australian Capital Territory and the Northern Territory don’t have legislative power to pass laws about voluntary assisted dying. But there are active efforts to repeal the Commonwealth law that prohibits the territories considering it.

Reflecting on Victoria’s experience In preparing the draft legislation, the Queensland Law Reform Commission had the opportunity to reflect on the emerging body of evidence about how the Victorian law is operating in practice.

While the safeguards in Victoria’s voluntary assisted dying system are working to ensure only eligible patients can access it, questions have been raised about challenges in accessing the law. For example, some people don’t necessarily know the option exists, while navigating the eligibility assessment process can be demanding.

Background like this from Victoria’s experience led the commission to recommend some departures from laws enacted elsewhere in Australia.

In Victoria, voluntary assisted dying laws have been operating for almost two years. Shutterstock

The commission’s approach aimed to design “the best legal framework for a voluntary assisted dying scheme in Queensland” and not to be “constrained by similar laws in other Australian states”.

In other words, the focus was on designing optimal law, rather than simply adopting another state’s law because it happened to be passed first.

How is Queensland’s proposed law different? Some features are common to all Australian voluntary assisted dying laws. For example, eligibility criteria broadly include requirements that a person has an advanced and progressive condition that will cause death, and they are suffering intolerably from it. The person must also be an adult, have decision-making capacity, be acting voluntarily and satisfy various residency requirements.

The Queensland proposal’s eligibility criteria are different in relation to the person’s life expectancy. A person is eligible for voluntary assisted dying under the Queensland bill if they are expected to die within 12 months. Under other Australian models, the period is six months, except for progressive neurological conditions, in which case it’s 12 months.

Although some commentators (including us) question the need for a designated time period, a 12- month limit is a more coherent approach than the existing six or 12-month approach elsewhere.

First, it’s very hard to justify having different time limits to access voluntary assisted dying depending on the nature of your illness.

Second, a longer eligibility period allows a person who is diagnosed with a medical condition more time to apply for voluntary assisted dying. This may allow patients to start the application process a little earlier, and reduce the likelihood they may die before accessing voluntary assisted dying (given the process can take some time).

Read more: Voluntary assisted dying is not a black-and-white issue for Christians – they can, in good faith, support it

Another novel feature is the Queensland bill limits the ability of institutions to object to voluntary assisted dying. This is an Australian-first as Victorian, Western Australian and Tasmanian laws only deal with permitting individual health professionals to conscientiously object.

This is important because there’s evidence in Victoria that institutions are blocking access to voluntary assisted dying. One media report described a Catholic hospice barring access to pharmacists delivering the voluntary assisted dying medication to a patient.

The commission recommends creating legislative processes so eligible patients’ access to voluntary assisted dying is not unreasonably hindered by institutional objections.

A person could be eligible for voluntary assisted dying under Queensland’s proposal if they are expected to die within 12 months. Shutterstock

Will the Queensland bill become law? After the bill is tabled in Queensland parliament next week, it will be referred to the Parliamentary Health Committee (which originally recommended reform). That committee will have a consultation period of 12 weeks.

Parliament is expected to vote on the bill in September, and if the law is passed, it will likely come into effect in January 2023. As in other states, a period of implementation ensures the voluntary assisted dying system is ready before the law takes effect.

As is usually the case in such debates, both major parties have offered their MPs a conscience vote. Although Queensland is the only Australian state never to have considered a voluntary assisted dying bill, its single house of parliament may mean the law is more likely to pass.

Further, given the growing national trend to permit voluntary assisted dying and the careful and measured law reform process, we anticipate Queensland is likely to pass voluntary assisted dying laws this year.

From Oregon to Belgium to Victoria

From The Conversation

Australia will, from mid-2019, once again join the list of countries that have legalised a person’s right to die if he or she is suffering unbearably. This comes after Victoria became the first state in the country to legalise voluntary assisted dying in November 2017 – more than two decades after the federal parliament struck down the Northern Territory’s short-lived euthanasia act.

The Victorian bill provides a model for physician-assisted suicide, where a patient can request and receive help to source the drugs necessary to bring about their own death. This is different to voluntary euthanasia, which typically requires another person such as a doctor to actively cause the death of the patient at the patient’s request. Under the Victorian model, there is scope for a doctor to administer the drugs if the patient is physically incapable of doing so themselves. To access the scheme, the patient must meet strict criteria. They must have an illness likely to end their life within six months (12 months for neurodegenerative conditions such as motor neuron disease) and be experiencing suffering that can’t be managed in a way tolerable to the patient. They must be over the age of 18 and a resident of Victoria.

Victoria’s model is pretty conservative compared to other jurisdictions. Some broaden eligibility to minors, non-residents and people suffering non-terminal conditions and disabilities. Others include access to both voluntary euthanasia and physician-assisted dying.

Here is a roundup of the laws around the world that permit assisted dying or euthanasia and ways in which they differ.

Oregon

Outcomes of the Oregon model have influenced debate in many jurisdictions, including Australia. Oregon passed its Death with Dignity Act in 1994. Finally taking effect in 1997, it is one of the longest-standing legislative schemes for physician-assisted suicide.

Oregon’s eligibility requirements are similar to those in Victoria. Assisted dying is available to adults over 18 who are capable of making decisions, have a terminal diagnosis with a life expectancy of six months and are Oregon residents.

The initial process for seeking assistance to die is also similar: a series of requests and evaluations over a period of time. Unlike the Victorian bill, though, the Oregon law doesn’t require patients or doctors to seek a licence or permit from the state prior to taking or allowing the medication. But doctors are required to report deaths to the state for evaluation purposes.

As of January 2017, 1,749 people had received prescriptions under the Oregon law since it came into force in 1997. Around 1,127 patients had died from ingesting the medications provided, 133 of these in 2016. Most participants (70%) were 65 years or older, and most (77.4%) had cancer.

The Oregon law has been remarkably stable. There was an unsuccessful attempt in 2015 to extend the eligibility period from six to 12 months. But the regulatory and eligibility criteria remain unchanged since 2006, when the law’s validity was last challenged in the courts.

Other US states to legalise assisted dying include Washington, Montana, Vermont and California. These are based on the Oregon model, but there is minor variation in process between jurisdictions.

Netherlands, Belgium and Luxembourg

In the Netherlands, Belgium and Luxembourg, both voluntary assisted dying and euthanasia are legal. There are no specific diagnostic requirements for access to the scheme for adults. The patient only needs to be experiencing unbearable suffering without prospect of a cure.

Patients accessing assisted dying and euthanasia in these jurisdictions have done so not only for terminal conditions but also non-terminal ones too. These include dementia, alcohol and drug addiction, mental illness and disability.

Read more: Separating fact from fiction about euthanasia in Belgium

Both Belgium and the Netherlands have reduced or removed age eligibility criteria to include minors. Since 2014, minors of any age who are terminally ill have been able to access assisted dying or euthanasia in Belgium, after a psychiatric assessment. In the Netherlands, children from 12 years can access the laws.

In the Netherlands, 6,672 people died as a result of euthanasia and 150 of assisted suicide in 2015 – or 4.6% of all deaths. This is consistent with estimates that assisted suicide or euthanasia accounts for between 0.3% and 4.6% of all deaths in jurisdictions where it is legal. Thus it remains relatively rare.

Switzerland

Despite being recognised as the first “euthanasia” jurisdiction, the Swiss system is somewhat of a legal irregularity, as the laws don’t expressly authorise physician-assisted suicide. Rather, while the Swiss Penal Code 1942 makes voluntary euthanasia and assisted suicide an offence in the case of “selfish” motives, it is silent on the status of assisted suicide for “non-selfish” motives.

As the system rests on an omission rather than an express scheme, there are no mandated eligibility requirements relating to age, residency, condition or prognosis.

Since the 1980s, not-for-profit organisations have interpreted this law as permitting them to provide assisted suicide services.

Canada

In the 2015 case of Carter v Canada, the Canadian Supreme Court ruled that a terminally ill patient has a right to a physician’s assistance in dying under the Canadian Charter of Rights and Freedoms. The case resulted in Bill C-14, which excludes from Canadian criminal laws those who provide assistance in dying to Canadian residents over the age of 18, with capacity to make decisions, who are suffering from a “grievous and irremediable” medical condition rendering the end of their life reasonably foreseeable.

Read more: Viewpoints: should euthanasia be available for people with existential suffering?

Bill C-14 has been challenged because of the “reasonably foreseeable” requirement. The British Columbia Civil Liberties Association has argued it is more restrictive than the finding of the Canadian Supreme Court in Carter, which required only that the plaintiff be experiencing intolerable suffering. That court challenge is continuing, while the law remains valid. Quebec, a province of Canada, has also legislated a form of euthanasia. Under Quebecois law, doctors must administer assistance personally and remain with the patient until they die. This imposes a greater burden on doctors than assisted dying models.

Colombia

Colombia permits both voluntary euthanasia and physician-assisted suicide to terminally ill adults. The practice is regulated by a set of guidelines published in 2015 by the Colombian Ministry of Health and Social Protection. The guidelines came some 20 years after the Constitutional Court ruled no person could be criminally liable for taking the life of a terminally ill patient who had consented.

In common with the Victorian model, the Colombian guidelines require prior external authorisation. However this is obtained from an external review committee in Colombia, rather the Secretary of the Department of Health, as in the case of the Victorian model.

Need a contra opinion on VAD – Look no further than The Spectator

The lies of euthanasia

On the hypocrisy of the progressive Left

By Tanveer Ahmed

The edifice of public support for euthanasia is built on a lie, that people know what they might want in the face of dying. The truth is almost all of us don’t, especially in a culture where there is a marked taboo around death.

Our inability to consider broader risks in the wake of the pandemic highlights our aversion to even consider facing our mortality. This feeds further misconceptions about painful death and end-of-life care, corrupting informed debate about assisted dying.

It is quite the contradiction when hundreds of millions of dollars are being spent on suicide prevention, yet the act is deemed perfectly rational in the face of life-limiting illness. Existential suffering remains at the heart of both.

There is overwhelming public support for assisted-dying laws. Public surveys in recent years hover around ninety per cent in favour.

Only this month South Australia passed a Bill in its Upper House. Victoria and Western Australia already have laws permitting assisted dying. Draft legislation in Queensland offers earlier access and includes the amorphous concept of mental trauma as a category. New South Wales is likely to introduce a bill in the coming months.

Doctors and religious groups are increasingly the last line against laws for assisted dying, defending what French author Michel Houllebecq calls ‘the honour of civilisation’. The Australian Medical Association is officially opposed but says it will cooperate with the public will, as long there is a right for individual doctors to undertake conscientious objection. Yet the public aren’t entirely aware that the pain most people associate with choosing an early death is usually more psychic than physical.

‘We wrongly associate those who choose euthanasia with intolerable physical pain, but they usually report an existential suffering, of being a burden or feeling abandoned by loved ones,’ says Associate Professor Leeroy Williams, President of the Australia and New Zealand Society of Palliative Medicine.

The existential torture is worsened in a society that does not have obvious idioms to process suffering. The modern climate is more therapeutic than religious.

The steep rise I see in diagnoses like post-traumatic stress disorder is in part because a psychological language replaces a lost metaphysical one. This is especially the case if life is framed as a quest for pleasure and its associated parallel, an avoidance of suffering.

In a pandemic era when the application of science in public policy has become central, one branch of medicine remains sidelined in the euthanasia debate.

That is the practice of palliative care. While doctors saving lives rightly enjoy hero status, helping people die better is neither sexy nor well paid.

Williams says it’s not just the public. Most health professionals are also poorly trained in end-of-life care. Monash University devotes one day in a six-year course to its medical students. Other medical schools or training programs don’t fare much better.

Yet in the past two decades managing nerve or bone pain has become more advanced. The delivery methods for artificial feeding have improved. There are also better strategies for minimising vomiting associated with cancer medications.

It is also the branch of palliative care that is best aware of the inaccuracies associated with giving a prognosis. Many patients are told they only have six or twelve months to live, yet survive years or even decades. A sizeable minority of patients, as much as between 15 and 20 per cent I am told, who are under palliative care are discharged home — and not to the Pearly Gates.

Given how poor our feelings are in computing probability and mathematics, you can bet a percentage of sufferers who go through with assisted dying would have otherwise survived. This is especially the case in the draft laws drawn up in Queensland where if you’ve received advice that death is likely within twelve months the assisted dying laws may apply.

Discussions about death are taboo in Western culture, something that is brought into striking contrast when burning pyres of corpses are broadcast from India. Cultures like India more readily accept that death is thoroughly intertwined with life.

In a world where assisted dying is legal, doctors are forced to contend with a new medical environment where assisted dying becomes thoroughly intertwined with the curing of illness. The so called ‘double effect’ of increasing pain medications like morphine knowing they are likely to induce death, something I have undertaken in hospital wards and in nursing homes, is in a very different legal and moral territory. While politicians and well-meaning advocates are cautiously assuring us of the opposite, there can be little doubt there is indeed a ‘slippery slope’.

In Netherlands there is now the ‘tired of living’ movement where there are demands that any elderly person over a certain age should be allowed to administer drugs leading to their death. In Belgium, fifteen thousand deaths have occurred throughout the process since the law was instituted in 2002.

There are multiple cases being fought in Europe over people euthanased for diagnoses like autism, deemed a form of ‘unbearable suffering’ and therefore meeting the legal test.

It is generally accepted that people should be allowed to do what they like with their bodies and their lives as long as they don’t harm others.

But a key facet of modern conservatism must be placing limits on the corrosive hyperindividualism of progressives, including many on the moderate side of the Liberal party.

This principle of autonomy reaches its zenith for rational suicide.

The act is fundamentally at odds with the field of mental health which frames suicide as pathological. There is a marked societal contradiction in prioritising suicide prevention and euthanasia simultaneously. We consider existential suffering unacceptable when there is no defined ‘life-limiting illness’, yet perfectly rational in the alternative setting.

But we live in a culture that struggles to process suffering and avoids all confrontation with death. Few people know what they might think about death when faced with its stark reality.

The polls suggesting widespread euthanasia support, views which inform enthusiastic legislation, wrongly assume the opposite.